News, Skilled Nursing Facility

Obstructing audits could now result in providers’ exclusion from Medicare and Medicaid

A new rule published on the federal register today by the Department of Health and Human Services (HHS) states that all individuals and entities convicted of interfering with or obstructing audits and investigations may face exclusion from Medicare and Medicaid. The HHS Office of Inspector General will be limited to a 10-year timeframe to pursue obstructed audits.

Grounds for exclusion include:

  • Ordering care services or items under Medicare or Medicaid funding without providing certain payment information to the Secretary
  • Referring residents or certifying the need for services or items that will not be provided by the referrer
  • Knowingly making or causing to be made false claims

Other changes stated in the rule include expanded authority to grant exclusion waivers, a narrowed scope of excluded providers convicted of substance abuse, an added early reinstatement process for providers who have lost their healthcare license, and other revisions to the OIG’s policies and procedures.

The full document can be accessed here.